The flexibility and mobility offered by mobile medical apps is important in a hospital setting where physicians require access to radiology images 24/7. This is the case at Klinikum Ernst von Bergmann in Potsdam, Germany. The hospital has proven in a study that these apps can be time and cost efficient.
The Challenges of Exchanging Information On Call
In the context of daily patient care, it is becoming increasingly important to include input from experienced colleagues from various clinical fields in the decision-making process. Obtaining this input becomes more of a challenge when physicians are on call and working outside normal hospital hours. Until now, this information exchange involved on-call physicians regularly commuting to and from the hospital and moving between internal departments to ensure they had access to all relevant clinical information.
As a result, the decision-making process was slow and resulted in additional costs for the employer. Time is often critical for the patient, such as in stroke diagnosis and treatment, when fast access to information is vital. In addition to this challenge, the routine transfer of image data (in particular CT and MRI) and the exchange of clinical information via phone poses organizational, technical, logistical, and data-protection obstacles and barriers, and therefore requires very careful planning. The goal of the project at Klinikum Ernst von Bergmann was to establish a feasible alternative.
Hospital Profile: Klinikum Ernst von Beargmann
Klinikum Ernst von Bergmann is a future-oriented hospital which focuses on core services. The hospital houses more than 1,000 beds and is recognized as the biggest and best-equipped hospital in western Brandenburg, Germany. In 2013, the hospital treated 56,000 outpatients in the ER, and more than 39,000 inpatients. Specialists from 29 departments offer services in diagnostics, therapy, and after-care all in one central location. There is an emphasis on interdisciplinary collaboration between the experts in certified centers, which include the breast center, the gastroenterology center, the tumor center Potsdam, and the specialist stroke unit.
Project Requirements and Participants
An integral part of the concept was the accessibility and availability of the clinical image information from radiology via the syngo.via WebViewer1. This meant allowing 24/7 remote access to the Siemens server. In addition, a fast, high-quality, and secure data transfer had to be guaranteed. Access needed to be password secured, and data protection required working instructions and approval. Finally, an easy-to-learn and user-friendly interface on a mobile device was essential. The iPad2 was the requested mobile device. The clinical participants in the study were the departments of neurology and neurosurgery – specifically, the physicians on call.
Between August 2013 and January 2014, the physicians in the departments of neurology and neurosurgery could access the syngo.via server and therefore the temporary radiology image storage system using their mobile devices outside regular working hours (i.e., 6 p.m. to 7 a.m., and on weekends and public holidays). The physicians were asked to perform a systematic evaluation of the technical components, and to complete a predefined questionnaire on the system’s functionality and ease of use, and the clinical course of the treated patients.
The parameters measured were the system usage in neurology/neurosurgery, the required time for image access, the number of visits to the hospital, the usability and performance, and the process.
Positive Results of the Study
In terms of system usage, 528 logins were registered through remote access in the six-month period. Moreover, the mean time for successfully loading images was 65 seconds. This time covers launching the application through to the first image viewing. Furthermore, the hospital-visit parameter showed an improvement. All neurological cases could be solved over the phone (with the help of teleconsultations), meaning a commute to the hospital was not necessary for the neurologist on call. In 75 neurosurgical cases, the physician on call had to go into the hospital, not because the teleconsultation failed but because surgical intervention was needed.
Usability and performance also developed positively. The acceptance of using the system on mobile devices was exceptionally high. Ease of use was rated 1.5 on average (on a scale of 1 = very good, to 6 = not acceptable).
The Cost Effects
Certain assumptions were made for the cost analysis. Firstly, the estimated compensation per hour of “active time on call” is €40. The average total time for a visit to the hospital by the on-call physician is 3 hours. Thus, the average cost per visit to the hospital by the on-call physician amounts to €120 (3 x €40). The average cost for a teleconsultation (i.e. use of syngo.via WebViewer in combination with a phone call) is €40.
Based on these assumptions, potential savings could be calculated. In the six-month period, a total of 528 calls with the on-call neurologists or neurosurgeons occurred. If they commuted to the hospital for each of these contacts, it would result in a total cost of €63,350 (528 x 3 hrs. x €40). In contrast, replacing all of these with teleconsultations would incur costs of just €21,120 (528 x 1 hr. x €40).
Conclusion and Outlook
At Klinikum Ernst von Bergmann, the possibility for on-call physicians to access radiological image data anywhere3 and at any time through mobile devices led to a complete process change in workflows in the neurological and neurosurgical departments. The reaction times in emergency cases outside of regular working hours decreased due to the possibility of prompt teleconsultations. The amount of time-consuming and, for the employer, cost-intensive in-hospital consultations by on-call physicians were significantly reduced by using teleconsultations. As a result, costs were also reduced. System acceptance was exceptionally high due to the user-friendly interface of the app and the ability to view images interactively.
To eventually offer an enterprise-wide, modern means of communication, Klinikum Ernst von Bergmann plans to roll out this pilot project to other hospital departments.